Prostate cancer screening: Thoughts from a patient
Posted Mar 05 2010 12:00am
I feel a duty to chime in on the revised guidelines on prostate cancer screening issued by the American Cancer Society. I was diagnosed with early-stage prostate cancer in September, 2008. I am currently under “active surveillance,” which means my urologist will evaluate my PSA and do a digital rectal exam every four months. If any future test worries my doctor, I would start treatment, which could involve surgery (prostate removal), radiation or radiation seeds. While my cancer appears to be early-stage and confined to the prostate, you never know how fast a tumor can grow.
I have mixed feelings about these guidelines. I’m not a urologist, so the following thoughts reflect my knowledge of the subject after talking with several doctors: While I like the suggestion that doctors should explain the pros and cons of PSA testing, I think every 50-year-old needs a PSA. The test should start years earlier if there are risk factors, as explained in the Reuters piece. When I was about 50, my doctor told me to get a PSA test. I’m glad I did. My PSA bounced up and down for quite a while before I was told to have a biopsy.
On digital rectal exams, I disagree with the guidelines, which downplay the test. These exams allow your urologist or primary care doctor to feel for abnormalities on the prostate. Why not go for any test that can provide a valuable clue.
Prostate cancer screening is frustrating. Yes, a high PSA doesn’t necessarily mean cancer. And some people can have significant cancers with low (or normal) PSA readings. Yes, the PSA tests can lead to anxiety. Not a fun part of the process, but the objective is to catch a prostate cancer when it’s small and confined to the prostate. That’s when the cure rate is good.
There’s a bright side to these revised guidelines. Perhaps more men will read about prostate cancer (and risk factors) and start scheduling regular doctor visits.